Super Vision
The Wish: clinical conflict iI
I want to paint a picture of what it was like for me when my psychoanalytic supervisor—someone whose opinion I highly value, someone who spoke at my analytic graduation ceremony, someone aware of all of my extracurricular psychoanalytic responsibilities, someone I’ve invested countless time and money with—asked me, a person passionately devoted to the study and practice of psychoanalysis, in an exasperated tone: “Do you want to do psychoanalysis?”
What made it so infuriating was that he had dropped the same question on me like an anvil only two months earlier. The first time it felt provocative. This time it felt like an existential attack on my identity. I had the fantasy of reaching through the phone—where our session was taking place—and ripping out his vocal cords. When I told him how furious I was that he asked this again, he replied, “It must’ve landed on something repressed to keep having this kind of reaction. There’s something there that needs to be looked at.”
As offensive as I found the question, it had pressed on something tender that felt central to my existence—something that, along with triggering an intense bout of narcissistic rage, had also piqued my curiosity. Having my desire to do psychoanalysis questioned by someone I respected compelled me to examine some of the unconscious wishes, fears, and conflicts that I had structured my life around.
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A crucial supervisory task is to provide a safe, nonjudgmental atmosphere where the analyst in supervision (or supervisee) feels free enough to share honestly about their process—to bring in clinical material that might feel embarrassing, but needs to be talked about. Experiencing sexual attraction to a patient is nothing by itself to be ashamed about, for example. Keeping this to oneself and refusing to talk about it, however, could be potentially disastrous. Supervisees must also feel free enough to talk about other issues, like showing up late to a session, going through the motions with a particular patient, or not enforcing one’s cancellation policy out of fear of a patient’s anger.
Exposing one’s thoughts and feelings in supervision, though, can feel even more vulnerable than it does in analysis. The setup, although not explicitly moralistic, has a heightened evaluative quality about it. Perhaps the transference in supervision feels even more acute because it evokes that analyst’s earliest experiences of learning right from wrong. Supervisors, of course, in whatever field, conjure the ghosts of our original supervisors and authority figures—our parents. All that to say, if the supervisee is committed to being as honest as possible—essentially talking about what they don’t want to talk about—it inevitably leads to a collision with authority.
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What had first attracted me to my current supervisor was how much he seemed to revere the unconscious. We first met in a seminar where he was the guest speaker. He stoked my curiosity about the unconscious by beckoning me, after I had given up on trying to articulate a particular idea, to keep pursuing the embryonic notion just on the tip of my tongue no matter where it led. I had worked with numerous supervisors before who helped me build my clinical repertoire, but none of them seemed to be so locked-in on tracking unconscious activity like he was. And there was something about that that made me feel like I could get closer and closer to the truth of my experience.
One of the first things that he made clear to me was that he didn’t make a strong distinction between supervision and psychoanalysis. Sometimes a supervisor will draw a firm line between what is appropriate to talk about in supervision and what is more appropriate to discuss in one’s analysis. That has always seemed heavy-handed to me. Having recently completed my second analysis (Adam Phillips, of course, said that an analysis is never finished, only abandoned), I welcomed the prospect of exploring my emotional experience more fully in supervision and growing from it.
I was apprehensive at first about sharing material with him that seemed to deviate from (my fantasy of ) his analytic belief system. I feared that he would disapprove of the clinical choices that had led to some of the analytic dilemmas I found myself in. At the same time, I realized that only by being unflinchingly honest and coming into contact with reality was I going to grow as an analyst. In the beginning, each time I told the truth (or an approximation of it), it felt like a leap of faith. Over time, that faith turned into trust. In the process, I was able to differentiate myself from my supervisor—to discover and fine-tune my particular way of working—while at the same time internalizing aspects of his analytic functioning that felt useful to me. In particular, I developed my capacity to tolerate the frustration of “not knowing” that the analytic encounter demands.
Perhaps no other analyst has written more about the connection between not knowing and apprehending a sense of truth than W. R. Bion. Bion was struck by something Freud wrote to Lou Andreas-Salomé: “When conducting an analysis, one must cast a beam of intense darkness so that something which has hitherto been obscured by the glare of the illumination can glitter all the more in the darkness.” This captures the essence of Bion’s later thinking: the “light” of prior understanding can block signs of emerging patterns from being perceived. Trying to remember past sessions, wanting the patient to change, and claiming to understand what’s going on all prematurely interfere with the analyst’s capacity to observe what is actually happening in the room with the patient right now and to get closer, with the patient’s collaboration, to the truth of their experience.
This perspective particularly appealed to me because when I first started practicing psychoanalysis, I wanted to be helpful. The paradox, of course, was that the more helpful I tried to be, the more I obstructed psychic growth from happening. My wish to be helpful sprang from a kind of anticipatory separation anxiety. Although the force of it lessens with one’s analysis and clinical experience, every analyst brings to their work a unique set of wishes and fears that show up in varying degrees with different patients. This was mine: if I could give the patient something useful, they would keep coming back, and if they kept coming back, they wouldn’t reject me. I’m drawn to Bion’s adage of having “no memory, no desire” in the session precisely because I’ve struggled with it so much.
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The exact impetus for my supervisor asking me whether I wanted to do psychoanalysis was, like any human motivation, overdetermined and not fully knowable. But I can still speculate. I realize that I can lapse into venting about certain patients who get under my skin for various reasons. There’s the patient who requests exceptions to my cancellation policy over email, which requires time and clinical thinking for me to figure out how to best respond. There’s the patient who keeps “forgetting” to pay his bill, but doesn’t want me to read into it. And then there’s the patient who is constantly calling in from a new remote location every session: in a coffee shop, on a bench outside, from their car. The problem was that I had been complaining about these pet peeves without much rigorous clinical thinking attached to what the behaviors might mean, and I imagine this came across as an aversion to doing the work in general.
I had also been working with a woman for several years whose unrelenting combination of hyperrationality, self-doubt, and helplessness was testing my conviction in my abilities as an analyst. I found myself repeatedly making uncharacteristically premature interpretations, almost against my will, in the vacuum created by her passivity. This only intensified the impasse, which then stoked my fear that the analysis would be interminable, which then led to more premature interpretations. After certain sessions, when the door closed, I experienced some version of what Michael Feldman calls “the bad analyst feeling”—an exquisite kind of analytic shame that comes from the experience of failing the patient that’s reminiscent of the child’s failed attempts to satisfy their parents. I had been talking in supervision for months about my despair about this case and my struggle to practice without memory and desire.
My hunch is that some sort of parallel process was taking place. A parallel process is when the interaction between the analyst and patient becomes recreated between the analyst and the supervisor. I was clearly annoyed by my patients and demoralized by just how difficult it was for them to change. Perhaps in my supervisor’s view, despite his best efforts, I was not changing all that much either. There was an uncontained frustration about the question (he would later admit he had become impatient), especially considering it was the second time he asked it. And yet, I could still appreciate the question because my intense reaction let me know there was something important there that I wanted to investigate.
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Model scenes are memories or constructions explored in psychoanalysis that serve to organize the central developmental themes of a person’s psychological life. When I was seven, I participated in the Pinewood Derby of Boy Scouts of America and lost. I don’t know why it was so devastating but it was. The next day, my parents, unable to tolerate my distress, bought me a trophy. In fourth grade, I took home a parakeet from science class for the weekend. When I returned from a sleepover with a friend, I couldn’t help but notice the bird looked different. My parents later confessed it had died and they had bought a new one to replace it, hoping I wouldn’t notice. In high school, I took the PSAT and got the sense that I flubbed it. Months later, my mom told me that the scores had been lost in the mail and enrolled me in a SAT course. Later, I found out that she had lied about the scores getting lost because I had bombed the test so badly and she didn’t want me to feel bad about it.
I was always a sensitive kid. My parents, unable to tolerate my disappointments, tried to protect me from reality. Consequently, I developed a degree of what Herbert Rosenfeld might call “thin-skinned narcissism” —a heightened sensitivity to rejection or criticism, a certain lack of resilience to setbacks, and a fragile sense of self that rotated on an axis of shame and grandiosity. Although undergoing two analyses had gone a long way to mitigate these tendencies, they still showed up in various ways in my intimate relationships, at work, and in supervision.
The paradox regarding his question was that on one level, after being shielded from reality by my parents in such formative ways, I had a conscious wish to seek out and be confronted by the truth. It clearly had something to do with my decision to become a psychoanalyst. My wish to hear the truth is why I can’t stand it when a patient says they want to put a “pause” on treatment when I know very well that I will never see them again. Or how much I hate it when a patient enacts their anger toward me indirectly, but denies it when I bring it up, rendering me impotent to address it. In this sense, I crave the truth.
At the same time, but on another level, my unconscious wish is to be protected from it. The wish for perfect attunement from significant others is a narcissistic defense against reality. If my supervisor had merely empathized with my frustrations, wouldn’t that have been just another iteration of my model scene—protecting me from the reality of a difficult situation out of fear that I couldn’t handle it? I probably would have been more receptive if he had asked me the same question in a more tentative way, but would that have pierced the veil of my archaic grandiosity? Would it have helped me help patients confront their own truths?
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After the question, I was away the next week so I had plenty of time to reflect. Honestly, I didn’t know whether we could continue working together. We had repaired and lived through the rupture of him falling asleep on me early in our work together. We had repaired the rupture when he asked me the first time whether I honestly wanted to do psychoanalysis. But a second time? Wasn’t there a limit to the number of ruptures a relationship could withstand? I didn’t know whether I had it in me to go through another round of repair. It gave me an excuse to fulfill my perennial wish to get rid of him and pursue the narcissistic fantasy of a gentler, more attuned supervisory experience.
I knew better, though. Bion, borrowing from Klein, writes that a sense of the truth is only possible when “the view of an object which is hated can be conjoined to a view of the same object when it is loved and the conjunction confirms that the object experienced by different emotions is the same object.” The supervisor I detested for questioning my desire was the same person I had appreciated for helping me grow so much in recent years. The situation felt untenable, yet I knew “getting rid of him” was the easy way out.
My transferential fear was that if I confronted him, he would assume the role of the parental authority figure, and I would take the complementary role of the tentative child trying to assert himself. I would freeze and be at a loss for words. The overriding wish, however, was to own the truth of my complexity as an analyst—something that up until that point I had not fully done. Lacan said, “The analyst’s authorization derives from her—or himself alone.” I committed to showing up to the next session and saying whatever was on my mind, as an equal, trying my best to hold together the part of him that I hated with the part of him that I loved.
To his credit and to my surprise, he didn’t retaliate. As Winnicott suggests, only when the mother survives the baby’s destruction can the baby grow out of the illusion of omnipotence, encounter reality, and develop a separate sense of self. Of course, I don’t want to do psychoanalysis, I told him. I hate it! It’s slow, it’s boring, and it’s rarely gratifying. Certain aspects of it, particularly around the frame, are the bane of my existence. Show me a psychoanalyst who says they love doing psychoanalysis 100 percent of the time and I’ll show you someone with a reaction formation. Even Freud, according to Ferenczi, let it slip that “patients are rabble . . . they are no good except to make a living from and to give material to learn from.” I had always accepted on an intellectual level that there were aspects of psychoanalysis that I hated, but now I could embody it.
An assumption in his question about my desire to do psychoanalysis (at least in my fantasy) was that he thought my going through phases of bewilderment and malaise meant that psychoanalysis wasn’t happening or that I didn’t want to do it. Psychoanalysis is a messy, nonlinear process filled with mistakes and long periods of having no clue what’s going on or even what psychoanalysis is. I’m okay with that. The question helped me come to terms with it. It quieted the sirens of the so-called analytic police always on patrol for crimes and misdemeanors committed against the psychoanalytic orthodoxy. I’m not claiming the right to conduct “wild analysis” but I am claiming the wish to be an ordinary analyst, working with vast uncertainty and trying my best to see in the dark, as I suspect most analysts are.
What is psychoanalysis even? There is, of course, no objective answer to the question. Psychoanalysis according to whom? There are as many forms of psychoanalysis as there are psychoanalysts, if not more. Psychoanalysis is, as the old saying goes, what a psychoanalyst does. I tend to agree with Bion, however, that “the psychoanalyst tries to help the patient to transform that part of an emotional experience of which he is unconscious into an emotional experience of which he is conscious.” Perhaps this is the goal of supervision as well.